Abstract

Background

Routine screening of scoliosis is a controversial subject and screening efforts vary
greatly around the world.

Methods

Consensus was sought among an international group of experts (seven spine surgeons
and one clinical epidemiologist) using a modified Delphi approach. The consensus achieved
was based on careful analysis of a recent critical review of the literature on scoliosis
screening, performed using a conceptual framework of analysis focusing on five main
dimensions: technical, clinical, program, cost and treatment effectiveness.

Findings

A consensus was obtained in all five dimensions of analysis, resulting in 10 statements
and recommendations. In summary, there is scientific evidence to support the value
of scoliosis screening with respect to technical efficacy, clinical, program and treatment
effectiveness, but there insufficient evidence to make a statement with respect to
cost effectiveness. Scoliosis screening should be aimed at identifying suspected cases
of scoliosis that will be referred for diagnostic evaluation and confirmed, or ruled
out, with a clinically significant scoliosis. The scoliometer is currently the best
tool available for scoliosis screening and there is moderate evidence to recommend
referral with values between 5 degrees and 7 degrees. There is moderate evidence that
scoliosis screening allows for detection and referral of patients at an earlier stage
of the clinical course, and there is low evidence suggesting that scoliosis patients
detected by screening are less likely to need surgery than those who did not have
screening. There is strong evidence to support treatment by bracing.

Interpretation

This information statement by an expert panel supports scoliosis screening in 4 of
the 5 domains studied, using a framework of analysis which includes all of the World
Health Organisation criteria for a valid screening procedure.